Need For Sutures Research Articles

Prospective observational study to evaluate the need for skin sutures to close laparoscopic skin incisions

It is considered to be normal practice to close laparoscopy trocar incision sites with skin sutures. We could not find evidence to show this had been validated by a clinical trial. The aim of this study was to assess the need for sutures from both a clinical and cosmetic point of view. Fifty female patients undergoing laparoscopy were randomly allocated into suture and non-suture groups. Patients were reviewed at 1 and 6 weeks. Using a visual analogue scale, a number of parameters including bleeding, bruising, infection and pain were evaluated. Results were recorded from the observer and the patient. Additional data regarding patients' satisfaction were also collected. These results were then analysed. After analysis, no statistical difference was demonstrated between the two groups for bleeding, bruising, infection or pain. Both groups were equally satisfied with their procedures and the cosmetic appearance of the scar at 6 weeks. They spent a similar time off work. The majority (59.1 %) of patients would prefer not to have sutures for subsequent laparoscopy. Conclusion: Laparoscopic incisions, which have haemostasis, do not require skin sutures either clinically or for cosmesis.

A Novel Approach to Ventricular Rupture: Clinical Needs and Surgical Technique

Cardiac rupture is a life-threatening event that often occurs after myocardial infarction and is often associated with significant death. Pericardiocentesis provides hemodynamic short-term improvement; however, patients with cardiac rupture require an emergency operation. This report describes a new procedure used to repair left ventricle free wall rupture after myocardial infarction. The technique described repairs the rupture off-pump and without the need for suturing. Midterm results demonstrate the feasibility and durability of this procedure.

Treatment of epulis fissuratum with carbon dioxide laser

Introduction Epulis fissuratum is a pseudotumor growth located over the soft tissues of the vestibular sulcus caused by chronic irritation from poorly adapted prostheses. The definitive treatment is excision with appropriate prosthetic reconstruction. The use of laser carbon dioxide (CO2) in the treatment of these lesions presents many advantages over conventional surgery including surgical technique without direct contact with tissue, without bleeding or need for sutures, minimal postoperative pain and edema. The haemostatic capacity of CO2 laser is describe widespread being a usefull instrument for oral surgery in patients that suffered from clotting disorders. Objective The aim of this article is to present a case of epulis fissuratum in a patient with antithrombotic medication demonstrating the usefulness of the CO2 laser for treatment of this lesion. Case report We present a case of a 72 years-old female, referred to Hospital Nossa Senhora da Conceição de Valongo, Porto, with growth of vestibular oral mucosa in the mandible and maxilla associated with ill-fitting prostheses, suggestive of epulis fissuratum. She was taking antithrombotic medication. These lesions were excised with CO2 laser. Three weeks after surgery, both areas were completely reepithelizaded. No significant complications were recorded as hemorrhage, pain, swelling or infection. Prosthetic rehabilitation and function were achieved with the fabrication of new upper and lower dentures. The patient was seen a month and 1 year after treatment lying free of recurrence. Conclusion The use of CO2 lasers are nowadays the Gold Standard in the excision of this type of pathology especially in patients with hemorrhagic diathesis or antithrombotic therapy.

Automated Lamellar Therapeutic Keratoplasty With Fibrin Adhesive in the Treatment of Anterior Corneal Opacities

To assess the visual outcome of using fibrin adhesive in automated lamellar therapeutic keratoplasty with a microkeratome in the treatment of anterior corneal opacities. In this prospective noncomparative clinical trial, surgery was done on 10 eyes belonging to 9 patients with anterior stromal opacity (macular dystrophy, spheroidal degeneration, scarring because of advanced recurrent pterygium, refractive surgery, or trauma). Depending on the depth of the opacity, a 130- or 250-μm flap was removed from the recipient cornea using a microkeratome. Then, a thin layer of fibrin adhesive was spread over the bed, and a lenticule with the same thickness, created from the donor cornea, was positioned in place. After allowing the glue to set for about 5 minutes, a bandage contact lens was placed over the cornea, which was removed 7-10 days postoperatively. All corneas healed properly, and none required suturing or reoperation. During the follow-up period, no inflammation or rejection was observed. The donor cornea and the donor-recipient interface remained clear in all cases. The mean of best contact lens-corrected visual acuity improved from 1.14 ± 0.53 to 0.51 ± 0.23 in the logarithm of the minimum angle of resolution scale. The fibrin glue can provide safe and effective attachment needed in automated lamellar therapeutic keratectomy and obviates the need for suturing. However, it requires improvement for easier and safer use in ophthalmology.

A Multi‐wavelength Fiber‐Optic Temperature‐Controlled Laser Soldering System for Upper Aerodigestive Tract Reconstruction

Laser soldering of a thick multilayer organ using conventional CO(2) lasers is ineffective. The purpose of this work was to develop a method for bonding the multilayer tissue of the upper aerodigestive tracts (UADT) without the need of sutures or stapling. Animal model. Academic research laboratory. The authors developed a multi-wavelength laser system, based on 2 fiber-optic lasers applied simultaneously. A highly absorbable CO(2) laser interacts with the muscular layer, and a nonabsorbable GaAs laser interacts with indocyanine-green solid albumin, placed between the mucosa and the muscular layer. The authors used an ex vivo porcine model to examine the capability of this system to effectively correct esophageal tears. The soldered esophagi burst pressure was >175 cm H(2)O (98% success rate) in 88 of the 90 experiments. A conventional CO(2) laser soldering resulted in insufficient bonding (mean burst pressure of 40 ± 7 cm H(2)O, n = 5), while the multi-wavelength laser system provided an ~9-fold tighter seal (359 ± 75.4 cm H(2)O, P < .0001, n = 15). Burst pressures after conventional suturing of the defect was significantly lower (106 ± 65.8 cm H(2)O, P < .001) than in the multi-wavelength laser system. Bonding of the UADT mucosa using a multi-wavelength, temperature-controlled laser soldering system can support significantly higher pressures then conventional CO(2) laser soldering and suture repair. The mean bonding pressure was 3.5-fold higher than the maximal swallowing pressure. Our findings provide a basis for implementation of new surgical tools for repair of esophageal perforations.

Tailored sutureless meatoplasty: A new technique for correcting meatal stenosis

ObjectiveStandard practice for meatoplasty includes the use of sutures to evert the mucosa. We present a novel technique that is equivalent to standard meatoplasty without the need for suturing. Materials and methodsA retrospective chart review was performed of patients who presented with primary meatal stenosis in 2007–2009. One group underwent a tailored, sutureless meatoplasty performed by one surgeon. The second group underwent a standard meatoplasty with mucosal advancement and suturing of the mucosal edges by another surgeon. Data were collected regarding demographics, presenting symptoms, symptom resolution, and postoperative complications. These were then compared between the two groups. Preoperative and postoperative uroflowmetry data were collected for the sutureless group to demonstrate objective improvement. ResultsOf 85 patients, aged 2–17 years, 60 underwent the tailored, sutureless procedure while 25 had a standard meatoplasty. The majority of patients presented with a deviated and/or narrowed stream of urine. There was no statistical difference between the two groups in regard to symptom resolution. Uroflowmetry data analyzed for 20 patients in the sutureless group demonstrated a significant improvement in Qmax and flow pattern; there was no significant change in % post-void residual. No patient had a complication in either group, or presented with recurrence. ConclusionsTailored sutureless meatoplasty is comparable to meatoplasty with mucosal advancement in resolving symptoms, improving uroflowmetry parameters, and complication rate, but is more efficient and cost effective.

COMPARISON OF 20-GAUGE TRANSCONJUNCTIVAL SUTURELESS VITRECTOMY WITH CONVENTIONAL VITRECTOMY

The purpose of the study was to compare the efficacy and safety of a transconjunctival sutureless technique for pars plana vitrectomy using conventional 20-gauge instruments versus the conventional technique. Clinical data were reviewed retrospectively for a consecutive series of patients who underwent transconjunctival sutureless vitrectomy (TSV; 38 eyes of 37 patients) and a control group who underwent vitrectomy using the conventional technique (38 eyes of 38 patients). Eighty-nine of 107 sclerotomies (83.2%) in the TSV group self-sealed without the need for sutures. The TSV group showed earlier visual improvement from baseline, as early as 7 postoperative days, compared with 60 days in the conventional group. This was attributed to less surgically induced astigmatism in the TSV group; mean astigmatism at baseline and postoperative days 7, 30, and 90 was -1.05 diopter (D), -2.53 D, -1.32 D, and -1.09 D, respectively, in the TSV group and -1.09 D, -3.91 D (P = 0.0285), -2.57 D (P = 0.0203), and -1.18 D, respectively, in the conventional group. No serious complications were observed in either group, including postoperative hypotony, wound leakage, or endophthalmitis. The 20-gauge TSV technique is as effective as the conventional technique and offers earlier postoperative recovery.

Sutureless Patch Graft for Sterile Corneal Melts

An innovative technique to seal large paracentral corneal melts is being presented. Two patients with sterile corneal melts sized 3-5 mm in diameter were treated with a full-thickness patch graft punched using a dermatological trephine and secured with the fibrin-aprotinin biological tissue adhesive, supplanting the need for sutures. The defect was adequately sealed, and successful tectonic support with postoperative best-corrected visual acuity of 6/24 was achieved in both cases, circumventing the need for an emergency full-thickness penetrating keratoplasty.

Initial Experience With 20-Gauge Transconjunctival Sutureless Vitrectomy Using Conventional Instruments

Purpose: To describe a transconjunctival sutureless technique for pars plana vitrectomy using conventional 20-gauge instruments. Methods: We performed transconjunctival sutureless pars plana vitrectomy (TSV) using conventional 20-gauge instruments in 36 eyes of 35 patients. We made 20-gauge transconjunctival beveled sclerotomies using microvitreoretinal (MVR) blades and used traditional 20-gauge instruments for the operations. Results: Eighty-three (81.4%) of 102 sclerotomies self-sealed without the need for sutures. The sutureless rate was even higher in the last one-third of the patients: 32 (94.1%) of 34 sclerotomy sites were sutureless. No serious complications were observed in our series, including postoperative hypotony, wound leakage, or endophthalmitis. Conclusions: The 20-gauge TSV technique is safe and can be utilized for almost all vitreoretinal diseases, without incurring additional cost for new instruments.

Design of a multiphase osteochondral scaffold III: Fabrication of layered scaffolds with continuous interfaces

There is a need to improve current treatments for articular cartilage injuries. This article is the third in a series describing the design and development of an osteochondral scaffold based on collagen-glycosaminoglycan and calcium phosphate technologies for regenerative repair of articular cartilage defects. The previous articles in this series described methods for producing porous, three-dimensional mineralized collagen-GAG (CGCaP) scaffolds whose composition can be reproducibly varied to mimic the composition of subchondral bone, and pore microstructure and mineral phase can be modified. This article describes a method, "liquid-phase cosynthesis," that enables the production of porous, layered scaffolds that mimic the composition and structure of articular cartilage on one side, subchondral bone on the other side, and the continuous, gradual or "soft" interface between these tissues: the tidemark of articular joints. This design enables the layered scaffolds to be inserted into the subchondral bone at an osteochondral defect site without the need for sutures, glue, or screws, with a highly interconnected porous network throughout the entire osteochondral defect. Moreover, the differential moduli of the osseous and cartilaginous compartments enable these layered scaffolds to exhibit compressive deformation behavior that mimics the behavior observed in natural articular joints.

Use of tissue adhesives in ophthalmology

Use of tissue adhesives in ophthalmology

Safety and efficacy of the electrothermal bipolar vessel sealer in trauma

The electrothermal bipolar vessel sealer (EBVS) was developed as an alternative to sutures, clips, and the ultrasonic scalpel for haemostasis during open and laparoscopic surgery. The purpose of this prospective clinical study was to objectively evaluate the performance of the EBVS during trauma surgery. Data from trauma cases, in which the EBVS was used, was collected prospectively for 19 consecutive months. Data collected included: total number of EBVS applications, need for additional haemostatic devices after application, calculated time savings or loss, and hemorrhagic complications. The EBVS was used in 23 trauma cases consisting of 13 small bowel resections, 4 ileocolectomies, 2 left hemicolectomies, 1 transverse colectomy, 1 right hemicolectomy with roux-en-Y gastrojejunostomy and duodenostomy, 1 Hartmann's procedure, and 1 splenorrhaphy with omental injury repair. A total of 631 applications of the device were used, averaging 27.4 applications per case. An additional suture ligature or clip placed for an inadequate EBVS seal (failure) was needed in only 1.5% of the total EBVS applications. All of these (10) occurred in one patient undergoing Hartmann's procedure for massive colonic injury. An additional 45 sutures or clips for non-EBVS failure were used in 5 cases due to proximity of bleeding to critical vascular, biliary, or bowel structures. In 17 trauma cases (74%) with intestinal resection no other means of hemostasis (sutures or clips) was required except the EBVS. The mean calculated time savings using the EBVS was 26.8 min (range 9.8-48) per case. There were no haemorrhagic complications. The EBVS is safe and effective for intestinal resections and haemostasis in trauma surgery. This novel energy source reliably seals major mesenteric vessels with little need for sutures or clips. Using the EBVS can substantially shorten operative time.

Uterine Exteriorization Compared With In Situ Repair at Cesarean Delivery

To compare extra-abdominal to intra-abdominal repair of the uterine incision at cesarean delivery. This is a randomized controlled trial conducted at the Instituto Materno-Infantil Prof. Fernando Figueira (Recife, Brazil). Inclusion criteria were indication for cesarean delivery and gestational age of 24 weeks or more. Patients with two or more cesarean deliveries, chorioamnionitis, hemorrhage, inability to consent, and previous abdominal surgery were excluded. Variables analyzed were nausea, vomiting, mean operative time, intraoperative blood loss, number of surgical sutures for uterine repair, postoperative pain evaluated by the visual analog scale, number of postoperative analgesic doses, surgical site infection, and endometritis. The analysis included 325 patients randomized for exteriorized uterine repair and 312 patients randomized for in situ uterine repair. A significant difference was observed in duration of surgery: lasting less than 45 minutes (44% with exteriorized uterus compared with 35.3% with in situ uterus, P=.02; number needed to treat=12) and less need of sutures (18.2% requiring one suture in the exteriorized group compared with 11.9% in the in situ group, P=.03; number needed to treat=16). The frequency of moderate or severe pain 6 hours after surgery was low [corrected] in women with in situ [corrected] repair (23.1%) when compared to those with the uterus exteriorized [corrected] (32.6%) (P=.026; number needed to treat=11). There was no difference between the groups in relation to other variables. There is no significant difference between extra-abdominal and intra-abdominal repair of the uterine incision at cesarean delivery, but the number of sutures is lower and surgical time is shorter with extra-abdominal repair, although moderate and severe pain at 6 hours is less frequent with in situ uterine repair. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00550888.

Real-time optical monitoring of radio-frequency tissue fusion by continuous wave transmission spectroscopy

Radio-frequency (RF) tissue fusion is a novel method of tissue approximation that can seal tissue without the need for sutures or staples, based on the combined effects of heat and pressure on the apposed tissue surfaces. RF delivery must be controlled and optimized to obtain a reproducible, reliable seal. We use real-time optical measurements to improve understanding of the tissue modifications induced by RF fusion. The main macroscopic transformations are thermal denaturation and dehydration. Light propagation in tissue is a function of both and therefore should provide interesting insight into the dynamic of occurring phenomena. Quantification by continuous wave technique has proven challenging. We proposed an algorithm based on the measurement of the absolute transmittance of the tissue, making use of the modified Beer-Lambert law. The experimental method and the data algorithm are demonstrated by RF fusion of porcine small bowel. The proposed optical measurement modality is well adapted to modern surgical instrumentation used for minimally invasive procedures.

Comparison of Healing after Cystotomy and Repair with Fibrin Glue and Sutured Closure in the Porcine Model

We compared healing after laparoscopic cystotomy using fibrin glue, sutures, or a combination to determine whether fibrin glue can obviate the need for sutures and whether there is any detriment when glue is used in the presence of sutures. In 24 Yorkshire pigs, a 3.5 cm vertical cystotomy was created laparoscopically and repaired as follows: Group 1--no closure; group 2--fibrin glue closure; group 3--suture repair; group 4--combined fibrin glue and suture repair. All animals had a Foley catheter for 1 week. In each group, three animals were harvested at 1 week (acute) and three animals were harvested at 6 weeks (chronic). Acute: Group 1--all pigs had an unhealed defect that leaked when evaluated by cystography. Groups 2, 3, 4--mean leak pressures were 80, 97, and 60 cm H(2)O (P = 0.36), respectively. Mean bladder capacity was not significantly different between groups. Chronic: No leakage seen on a cystogram at 1 week; at 6 weeks, bladders were filled at > or =95 to 100 cm H(2)O without leakage. Histologically, there was more inflammation in the acute group v chronic group pigs. In the acute group pigs repaired with glue or suture + glue, there was more inflammation and less epithelial continuity than in the suture alone group. At 6 weeks, there was no difference between groups. Fibrin glue provoked an intense inflammatory response that might have delayed healing acutely, resulting in a lower burst pressure in both scenarios in which it was used (i.e., alone or in combination with sutures). However, by 6 weeks, there did not seem to be any difference between groups either clinically or histopathologically.

A new technique in sutureless aortic valve replacement–preliminary results

Introduction: The Arbor-Trilogy-aortic-valve presents a new concept in aortic valve replacement (AVR). This bovine pericardial valve consists of a flexible, stand alone gasket which is similar to an annuloplasty ring and a bovine pericardial valve (crown). Because of the use of Tissue-Retention-Elements deployed with a rapid fire delivary tool of fixing the gasket to the annulus there is no need for suture. The valve crown is mounted onto the gasket using a guiding and locking mechanism. After implantation the valve leaflets open into the sinuses thereby presenting a large orifice area and hence a minimal transvalvular gradient. Presented are the early results of a feasibility study performed in our clinic. Methods: From November 2006 to May 2007 four patients received an AVR using the Arbor-Trilogy-aortic-valve. All presented with a severe aortic stenosis (mean gradient 69±24mmHg; mean orifice area 0,5±0,05cm2). Results: No perioperative deaths. Valve implantation took 22±7min in the first 2 patients and 10±4min in the next patients. All received a 23mm valve and had an uneventful postoperative course. Three months echocardiography showed no hemodynamic relevant aortic regurgitation in all patients, the mean gradient was 7,7±2,6mmHg, the effective orifice area was 1,8±0,3cm2. Conclusion: Although these four patients present our earliest experience with this valve it shows the feasibility of the technique and the excellent hemodynamic performance of the valve. We hope that these results will be further emphasized by our ongoing experience and that the improved hemodynamics will have a positive impact on valve longevity and longterm patient outcome.

Sutureless vitrectomy

Sutureless vitrectomy has rapidly been accepted as an essential part of a vitreoretinal surgical setup. The size and structure of the wound along with near intact conjunctival covering makes the incision self-sealing and safe. This allows the vitrectomy instruments to be used without creating an initial limited peritomy to expose bare sclera, and obviates the need for sutures at the end of the procedure. Wound construction is the essential step in ensuring postoperative wound stability. Both one-step and two-step wound constructions have been described. Key points include an oblique, tunneled approach to ensure a valve-like effect as well as misalignment of conjunctival and scleral wounds by displacing conjunctiva during construction. Advantages include decreased operative times in certain cases and decreased postoperative inflammation, early postoperative rehabilitation, improved patient comfort, and minimal conjunctival damage. Complications are based around wound competence, hypotony, and its relationship to endophthalmitis rates. Early reports highlighted an increase in endophthalmitis though further studies are required to accurately assess the incidence. Endophthalmitis has not been reported in cases that underwent fluid/air exchange. This review focuses on techniques, benefits, complications, personal experiences, and the safety profiles of sutureless vitrectomy systems. A literature review was undertaken using 'Medline' and 'Pubmed'. Search terms included sutureless vitrectomy, 20 gauge, 23 gauge, 25 gauge, and transconjunctival and small gauge vitrectomy.

Nd:YAG and Diode Laser in the Surgical Management of Soft Tissues Related to Orthodontic Treatment

The aim of this clinical study was to observe and evaluate the surgical management efficiency of soft tissues during orthodontic treatment. Thirty-seven young patients were selected and treated by laser-assisted surgery before or during orthodontic treatment and were classified by sex, age, and type of surgical management. Three different wavelengths were used (diode 810 nm, diode 980 nm, and Nd:YAG 1064 nm) in different surgical situations: maxillary vestibular and lingual frenectomies, surgical exposure and alignment of ectopic or retained teeth, and re-contouring gingival overgrowth. In all evaluated patients, the laser treatment was performed without local anesthesia or sutures. Only topical anesthetic was needed. These use of these wavelengths of laser energy was a noticeable aid in the surgical management of soft tissues before or during orthodontic treatment. The benefits of laser treatment include reduced bleeding during surgery with consequent reduced operating time and rapid postoperative hemostasis, thus eliminating the need for sutures. The lack of need for anesthetics and sutures, as well as improved postoperative comfort and healing, make this technique particularly useful for very young patients.

Pars-plana-Vitrektomie mit Infusionszugang über eine korneale Parazentese bei pseudophaken Augen

More than 50% of vitrectomies are performed in pseudophakic eyes. There is free communication between the anterior segment of the eye and the vitreous cavity through the zonular fibres of the lens. This means it is possible to use a primary anterior chamber infusion for pars-plana vitrectomy. For some years, therefore, we have used an anterior chamber approach for the infusion cannula when carrying out such simple vitreo-retinal procedures as silicone oil removal or macular pucker peeling in pseudophakic eyes. In all eyes the anterior chamber access was placed via a corneal paracenthesis and during all vitrectomies it was held in place by corneal tissue tone with no need for suturing. Secure wound closure was also achieved without suturing by simply swelling the paracentesis. Conventional sclerotomies were closed with absorbable sutures. During vitrectomy the infusional flow was sufficient to ensure adequate intraocular pressure regardless of intraocular lens type and diameter. In pseudophakic eyes the anterior chamber infusion approach by way of a paracentesis is a safe way of reducing surgical trauma during vitrectomy. It must, however, be borne in mind that when an endotamponade is applied it is necessary to switch the infusion to one of the sclerotomies.

Bloodless hepatic resection with automatic bipolar radiofrequency generator and multielectrode device

Liver resection is a standard treatment for liver tumours. Intra‐operative blood loss remains a major concern during liver resection due to its association with higher postoperative complications and shorter long‐term survival. To perform bloodless hepatic resection we realized an apparatus consisting of an incremental, bipolar radiofrequency generator and a probe with six in‐line needles (SURTRON SB). Several ex‐vivo and in‐vivo pig liver experiments and a first‐phase clinical study allowed the realization of a prototype radiofrequency (RF) generator that works at 470 kHz, 150 watts maximum power delivered. The probe consists of six needle electrodes of 1.5 mm diameter, with 4.5 mm free space, 6.0 mm centre to centre, between each. We obtained a coagulation of 35 mm length and 12 mm width. The transection was performed with a common scalpel after coagulation of liver parenchyma. We observed good healing of the liver edge both in animal model and in ongoing pilot clinical study. Coagulation with SURTRON SB allows a feasible, easy and safe bloodless liver resection. This method is tolerated with no systemic complication or adverse reaction. This technique offers a method for a bloodless hepatic transection without the need for sutures, ties, staples or tissue glue.